CBME Program Specific Resources

Competence by Design Roll-Out Timelines & Cohorts

The RCPSC will be implementing CBD in phases and developed a roll-out schedule of seven cohorts. The first medicine adopters are medical oncology in cohort one and internal medicine and gastroenterology in cohort two. The Royal College of Physicians and Surgeons of Canada provides up to-to-date information on the roll-out schedule and cohorts.

Emergency Medicine

A message from the Program Director, Dr. Nazanin Meshkat

July 2018 marks a landmark in the history of medical education as we launch Competence by Design in our Emergency Medicine program.

A few years back, on a shift like any other shift, I recall working with a PGY 1 resident who kept apologizing for not being “capable” of handling all the cases he’d seen that night. I found the expectation surprising…after all, how would a PGY1 manage “all cases”?

At the same time the feeling was naggingly familiar.

Walking home, leaving behind the flurry of the shift, I remembered why. Rewind back to my time in medical school and residency, and I had experienced that same sentiment…any time I was not able to manage a case I was acutely aware of my limitations, and the failure felt crushing. The need to be excellent was overwhelming…and frankly crippling at times, stunting growth and a necessary process in my journey to learn. Intellectually, we all know that the road to competence is a long journey, bumpy, and with lots of ups and downs. Emotionally, there is a dissonance of a never-ending need for positive feedback, and a devastating emotional response to constructive feedback. This has led to a dysfunction – a dysfunction in our ability to give and receive feedback.

Competence by design is a crossroad in our trajectory as individuals, educators, programs, and clinicians. With more accurate, varied, and focused assessments, we have the opportunity to engage our learners in their learning, and rewiring us not only to solicit and incorporate feedback, but also to give feedback.

The experience so far with programs that have implemented Competence by Design, is that yes, the rewiring was hard at first…until the tipping point was reached. Join us in our climb to the tipping point. Below you will find some resources that will help in your journey.

Introduction to CBD in the Division of Emergency Medicine

Timeline of Implementation

Emergency Medicine's Timeline Chart

Professor Watling on Feedback 

 Visiting Professor Day Dr. Watling's Bio   December 6, 2017

Site Visit Dates

  • UHN - CBD Introduction 
    Presenter: Tim Dalseg
  • Sunnybrook - CBD Introduction
    Presenter: Alex Stefan
  • SMH - CBD Introduction 
    Presenter: Melissa Chacko

January 18, 2018

January 19, 2018

February 8, 2018

Emergency Medicine's CBD Grand Rounds   April 18, 2018

Assessment Tool Training Sessions

  • SMH- Intro to CBD Assessment Tools
  • UHN - Intro to CBD Assessment Tools
  • Sunnybrook - Intro to CBD Assessment Tools

1-011 Bond Conf Room
TWH, Fell Pavilion, 6th floor, room 103
SHSC ED Conference Room (AG143)

June 14, 2018 @ 8:30
June 28, 2018 @ 10:45
June 8, 2018 @noon

CBD Launch Date   July 1, 2018

Competence Committee

The Competence Committee makes promotion recommendations based on a framework of entrustable professional activities (EPAs) used to determine competence. It can also help arrange support for residents who are having difficulty achieving an appropriate level of competence at their stage of training.



Fact or Fiction? Can residents finish their whole program in just one week? Will CBD make you look ten years younger? Do you have a sneaking suspicion that CBD is a plot to make our residents the best emergency docs ever? (hint, that last one’s true…) We’re exploring the myths and legends of CBD! Do you have a burning question about CBD? Chances are others are wondering the same thing! Submit it here to be included in our ongoing Mythbusters series: division.em@utoronto.ca.

Fact or Fiction Fact Fiction
The length of the residency program will vary depending on the resident   Fiction! While some models of Competency-Based Medical Education (CBME) allow flexibility in the timing of training, in the Royal College CBD model, the overall residency program length won't change.
All postgrad programs are implementing CBD. Fact! This is a national initiative through the Royal College of Physicians and Surgeons of Canada. Specialties across the country will be implementing CBD over the next decade.  
Feedback is going to take me a whole lot of time.   Fiction! In the CBD model, instead of trying to assess a learner's overall performance, you'll have very targeted areas of focus. There's always a learning curve when starting something new, but after the dust has settled, this new system will be more efficient for you and more effective for your learners!
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